BACKGROUND: Advanced airway management is a research priority in prehospital care. There is a high burden of major trauma in KwaZulu-Natal (KZN) Province, South Africa (SA), and transfer times to trauma units are often prolonged OBJECTIVES: To examine emergency intubation practice in trauma and burns patients in Pietermaritzburg, KZN, and its environs METHODS: This was a prospective consecutive case series, conducted from 11 May to 17 July 2016. Data were collected from urban emergency department (ED), rural hospital and roadside procedures in Pietermaritzburg and its drainage area. Patients with emergency intubation following trauma were eligible for inclusion. The primary outcome was successful airway management. Secondary outcomes included first-pass success and adverse events. RESULTS: Forty-one cases were recorded in patients aged 1 - 60 years. No instances of unsuccessful airway management were reported. Recorded first-pass intubation success rates were higher in receiving EDs than rural hospitals (19/22 v. 2/7; p=0.003). Use of a formal preintubation checklist was associated with a higher first-pass success rate (21/23 v. 6/15; p=0.001) and fewer adverse events (0/23 v. 7/16; p0.001). Identified adverse event rates were 1/22 (EDs), 5/8 (rural hospitals) and 2/9 (roadside). Unmedicated intubation was more common in rural hospitals than EDs (3/8 v. 1/22; p=0.019), despite absence of cardiac arrest in these cases. Minimum standards of anaesthetic monitoring were not consistently met in any setting CONCLUSIONS: The use of a preprocedural checklist was associated with improved intubation outcomes and may improve practice in SA trauma care and the prehospital environment, including in rural hospitals. Standardised rapid sequence induction protocols, routine use of introducers and end-tidal carbon dioxide monitoring, and increased availability of intraosseous devices also merit consideration. Key performance indicators should be monitored routinely.
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机译：背景：先进的航空管理是在前护理的研究优先考虑。 Kwazulu-Natal（KZN）省，南非（SA）的主要创伤负担，并转移到创伤单位的时间往往是延长的目标：检查创伤的紧急插管实践，烧伤Pietermaritzburg，KZN和Burns患者它的环境：这是一项前瞻性连续案例系列，从2016年7月11日至7月17日进行。从城市急诊部（ED），农村医院和路边程序中的数据收集到Pietermaritzburg及其排水区。创伤后应急插管患者有资格包含。主要结果是成功的气道管理。二次结果包括首先取得成功和不良事件。结果：1至60岁的患者中记录了44例病例。没有报告不成功的航空管理局的情况。在农村医院接收EDS时，录制的首先通用插管成功率更高（19/22 v。2/7; p = 0.003）。使用正式的预介金清单与更高的首次取得成功率（21/23 v.6 / 15; p = 0.001）和更少的不良事件（0/23 v。7/16; p <0.001）相关联。确定的不良事件率为1/22（EDS），5/8（农村医院）和2/9（路边）。尽管在这些情况下没有心脏骤停，但在农村医院的插管更常见于农村医院（3/8 v.1 / 22; p = 0.019）。在任何设置结论中，不始终会满足麻醉监测的最低标准：使用预先核对清单与改善的插管结果有关，并可改善SA创伤护理和预孢子环境的实践，包括在农村医院。标准化的快速序列感应协议，常规使用引导仪和终末潮汐二氧化碳监测，以及骨内装置的可用性也是值得考虑的。应经常监测关键绩效指标。
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